Abstract:This small, clinical cohort showed no significant association between mothers' prenatal exposure to lithium or mood disorders and their offspring's IQ.
“…One child in this study was diagnosed with minor neurological dysfunction without clinical implications. A recent study compared the intelligence quotient (IQ) in children with in utero exposure to lithium (n = 20), non-exposed children of mothers with a mood disorder (n = 8) and controls (n = 11) and reported no difference in total, performance or verbal IQ (Forsberg et al 2017).…”
Section: Consequences For the Developing Childmentioning
Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.
“…One child in this study was diagnosed with minor neurological dysfunction without clinical implications. A recent study compared the intelligence quotient (IQ) in children with in utero exposure to lithium (n = 20), non-exposed children of mothers with a mood disorder (n = 8) and controls (n = 11) and reported no difference in total, performance or verbal IQ (Forsberg et al 2017).…”
Section: Consequences For the Developing Childmentioning
Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.
“…evaluated children whose mothers were treated with lithium during pregnancy when they reached four to five years of age. This small study showed no significant associations between the mothers’ prenatal exposure to lithium or mood disorders and their children's intelligence quotients .…”
Section: Lithium Exposure In Utero Did Not Seem To Affect Cognitive Dmentioning
Wrapping babies in newspapers keeps them warmHypothermia in newborn infants has been strongly associated with mortality and morbidity. A randomised trial by Agrawal et al. studied preterm infants in India who were wrapped in two cloth sheets with a newspaper layer between them straight after delivery. They found they had a higher body temperature when they arrived at the neonatal intensive care unit, and after one hour, than infants who were just wrapped in the cloth sheets (1). The authors concluded that newspaper may be a useful and inexpensive heat retention method when vinyl bags are unavailable. Andersson comments on the findings (2).
“…All eight studies included in this study were conducted in high-income countries, which limits the generalizability of the findings to other populations. The Finnish PREDO study [3] and the Swedish clinical cohort study [29] examined European Nordic populations. The French EDEN [12], and Irish O'Leary [32] studies comprised southern European populations, while the Dutch Generation R studies [30,33] comprised a multiethnic European population.…”
Section: Discussionmentioning
confidence: 99%
“…The studies that found no significant associations in unadjusted or adjusted models are the Greek Rhea Study on prenatal depressive symptoms and child neurodevelopment [28], among 288 motherechild dyads, and a small Swedish study [29] of 39 children who were exposed to maternal mood disorders during pregnancy treated with lithium, to maternal mood disorders during pregnancy not treated with lithium, and who were not exposed to either one. The study that did not find associations and reported adjusted associations only is the multiethnic Dutch Generation R study among 5001 and 1994 motherechild dyads [30].…”
Maternal mental health problems during pregnancy, especially mood and anxiety disorders and symptoms, are common. They not only hinder maternal well-being and health during pregnancy but also are associated with physical and mental health adversities in the offspring. We provide here a review of the studies published between 2017 and 2019, which reported on the associations between maternal mental health problems during pregnancy and child neurocognitive outcomes. We identified eight studies, which reported a mixed pattern of findings. While the balance of evidence favors lack of associations, small sample sizes and heterogeneity in study designs, exposures, outcomes, and covariate adjustments between the studies preclude firm conclusions. The reviewed studies encourage further research filling in the knowledge gaps we identified.
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